While diabetic foot ulcers account for the majority of neuropathic ulcers on the foot, ulcers can be also be caused by the blockage of the arteries supplying blood to the foot, malignancies, venous insufficiency, rheumatoid arthritis, and other medical conditions. The use of the Total Contact Cast should be limited to neuropathic wounds and Charcot Neuroarthropathy. Charcot Neuroarthropathy can occur from any medical condition rendering the foot insensate.
There have been many versions of “total contact casts” and this approach has proven to be efficacious. The total contact cast fits the patient leg and foot very closely. It touches or is in contact with the whole foot. The total contact cast has a layered plaster/fiberglass shell with a walking heel on the bottom. However, where the cast fits under the wound, there is a layer of soft foam that functions as the primary dressing over the wound to absorb exudates without creating maceration of the surrounding healthy tissue. The soft foam over the wound protects it while it heals and minimizes disruption of healing when it is removed at each cast change. The total contact cast off-weights the wound site or fractured bones, allowing healing to proceed without excess pressure on the area. Wearing the cast will allow most foot ulcers to typically heal in six to eight weeks. The initial cast is usually changed one to two days after it is applied. After that, a new cast is typically put on every week until the patient is ready to again wear shoes.